CMS announces new model to address impact of the opioid crisis for children

Model to focus on children in Medicaid and CHIP who have physical and behavioral health needs, including substance use

Today, the Centers for Medicare & Medicaid Services (CMS) announced a new Innovation Center payment and service delivery model as part of a multi-pronged strategy to combat the nation’s opioid crisis. The Integrated Care for Kids (InCK) Model aims to reduce expenditures and improve the quality of care for children under 21 years of age covered by Medicaid and the Children’s Health Insurance Program (CHIP) through prevention, early identification, and treatment of behavioral and physical health needs. The model will empower states and local providers to better address these needs through care integration across all types of healthcare providers.

The InCK Model will help state Medicaid agencies and their local health and community-based partners identify and address risk factors for behavioral health conditions, understanding that the earliest signs of a problem may present outside of clinical settings—such as in schools or at home—and may be known not to clinicians but rather to teachers and to child welfare and foster care programs. The interventions outlined in the InCK Model are designed to respond to this crisis by supporting state Medicaid agencies and local health and community-based partners to increase access to behavioral health for vulnerable children and build capacity in communities to provide more effective, efficient, and affordable care through home- and community-based services.

While the existing, required Medicaid Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit is comprehensive, variation remains among states in how and when children receive behavioral health screening, diagnostic and treatment services. In addition, despite the variety of federal, state, and local services that do exist to support children’s health, limited information sharing and differing eligibility and enrollment processes have created barriers to putting children and families at the center of their care and coordinating across services.

InCK Model participants will benefit from systematic integration, coordination, and management of core child services, including clinical care, school-based health services, housing, and other health-related supports. The InCK Model aims to positively impact the health of the next generation through early identification and treatment of behavioral health risk factors of children up to age 21 covered by Medicaid and CHIP in selected states. Testing the use of a state-specific payment model to cover integrated care coordination and case management, the InCK Model will be tailored to the unique challenges faced by providers and patients at the local level, ultimately leading to long-term improvements in child health services and health outcomes.

The CMS Innovation Center anticipates releasing a detailed Notice of Funding Opportunity in Fall 2018 with additional details on how state Medicaid agencies and local health and community-based organizations can apply to participate in the model. CMS intends to award funding for up to 8 states at a maximum of $16 million each in as early as Spring of 2019 to implement the seven-year model.

The CMS Innovation Center was established by section 1115A of the Social Security Act to test innovative healthcare payment and service delivery models to reduce program expenditures while preserving or enhancing the quality of care for those individuals who receive Medicare, Medicaid, or CHIP benefits.

For a fact sheet on the InCK Model, click here.

For more information on the InCK Model, click here.